RCxRules automatically reviews 100% of diagnosis codes coming out of your EMR to ensure correct HCC codes are captured. Schedule a 15-minute meeting to learn more.
Schedule 1:1 MeetingRCxRules helps healthcare organizations improve RAF scores through increased HCC capture/re-capture rates. Our HCC coding automation software increases coder productivity by identifying high-value encounters with HCC coding gaps. This reduces the coding burden on providers allowing them and coders to focus on what they do best—deliver quality care and perform accurate coding.
Integrating with leading EMRs and PM systems, our software ensures initial claims have the most accurate HCC data—every time, guaranteed.
Providers aren’t coders—let them focus on patient care and have coders do what they do best. Your physicians work diligently to treat patients and document their conditions in their clinical notes. Turning this wealth of information into the correct coding requires the specialized skill set of coders. Our automated coding workflow eliminates the need to manually review every claim, enabling HCC coders to work with maximum efficiency.
Retrospective chart reviews have been a necessary fact of life for groups addressing their HCC coding challenge. But this process is redundant, manual, and expensive. RCxRules’ automated, concurrent coding workflow reviews 100% of your HCC encounters, flagging errors before they are submitted as a claim, not after. Let your coders focus only on the encounters that require their attention.
Make sure your patient-centered physicians are properly paid for the cost of providing excellent care. Since RAF scores drive the reimbursement in value-based programs, getting the HCC coding correct is critical to ensuring you are compensated appropriately (especially for those high-touch patients that require extra time and attention).
Providers are busy—their time is valuable and in short supply. They respond well to data, but only if it is timely and relevant. Traditionally, data and trends are compiled with a one or two month lag and often lacks details needed to effect process change. Since RCxRules manages the HCC coding process in real-time, you can give your providers information on their coding performance and documentation accuracy in the moment.
Providers aren’t coders—let them focus on patient care and have coders do what they do best. Your physicians work diligently to treat patients and document their conditions in their clinical notes. Turning this wealth of information into the correct coding requires the specialized skill set of coders. Our automated coding workflow eliminates the need to manually review every claim, enabling HCC coders to work with maximum efficiency.
Retrospective chart reviews have been a necessary fact of life for groups addressing their HCC coding challenge. But this process is redundant, manual, and expensive. RCxRules’ automated, concurrent coding workflow reviews 100% of your HCC encounters, flagging errors before they are submitted as a claim, not after. Let your coders focus only on the encounters that require their attention.
Make sure your patient-centered physicians are properly paid for the cost of providing excellent care. Since RAF scores drive the reimbursement in value-based programs, getting the HCC coding correct is critical to ensuring you are compensated appropriately (especially for those high-touch patients that require extra time and attention).
Providers are busy—their time is valuable and in short supply. They respond well to data, but only if it is timely and relevant. Traditionally, data and trends are compiled with a one or two month lag and often lacks details needed to effect process change. Since RCxRules manages the HCC coding process in real-time, you can give your providers information on their coding performance and documentation accuracy in the moment.
The RCxRules engine integrates with your EMR and revenue cycle management systems to verify HCC coding data before claim submission. Correct HCC encounters pass through automatically, while those needing review are sent to your coders to be resolved. We take rich data sets from your existing systems and turn them into actionable insights within the coding workflow to eliminate the need for redundant, retrospective review. Our HCC coding solution workflow consists of:
Whether you rely on RCxRules, or an existing EMR or population health solution, it’s critical to identify your high-risk patients prior to their appointments and to prepare providers ahead of their visits for recapture opportunities.
After the patient visit, RCxRules ensures 100% of encounters are automatically evaluated for diagnosis accuracy and completeness. Then, only those encounters with coding gaps are flagged and routed for coder review before being submitted as a claim.
Providers need real-time insights into their coding patterns and documentation accuracy. Timely and relevant data is essential to meaningful physician engagement and measuring the financial impact of your HCC coding team.
RCxRules complements your population health management software. Population health systems do a great job of identifying high-risk patients and even identifying missing HCC codes. RCxRules takes this critical data and incorporates this information directly into the coding workflow. RCxRule’s focus is on improved HCC coding capture rates and ensuring accurate HCC codes are documented before they’re submitted as a claim. This focus on the HCC coding workflow and concurrent review is outside the scope of the leading population health solutions in the market.
We firmly believe that robust pre-visit planning is essential to any successful HCC coding strategy. If you already have a process in place that works well for you, that’s great. RCxRule’s HCC coding workflow easily complements a variety of pre-visit planning strategies. Regardless of the approach, RCxRule’s essential value proposition is automating the review of all patient encounters (concurrent HCC review) to ensure the expected HCC codes were actually captured and will be transmitted to the payer.
A retrospective HCC coding review process occurs after the initial claims have been submitted to a payer. This process is helpful in having coders find HCC opportunities that are reflected in the clinical document, but not captured in the diagnosis coding. While this process is helpful, it’s typically a highly manual process and requires the review of encounters twice (once for the initial claim and again for the retrospective review). Additionally, the process for submitting the newly identified codes through an alternate submission methodology adds redundant time and effort. RCxRule’s approach to HCC coding is to quickly and efficiently address this on the front end. We enable HCC coders to review claims in real-time so accurate HCC coding is captured on the initial claim submission.
No, RCxRules lets your team focus on what they do best. Your providers can continue providing excellent patient care, while coders work out of RCxRules in a process that supports provider’s clinical documentation efforts. Within RCxRules, coders review HCC coding errors before claim submission.
No, RCxRules is designed for the HCC coding process and the standard fee-for-service coding process to function smoothly and efficiently together (see our Revenue Cycle Rules solution). Our HCC coding solution isolates only those HCC encounters needing coder review and directs to a dedicated HCC coding queue. This workflow mirrors the automated review of traditional fee-for-service claims for accuracy before claim submission implemented by virtually all revenue cycle operations.
RCxRules has the built-in intelligence to detect data issues in risk-based patient encounters and fee-for-service based encounters and to automatically direct to the appropriate teams for resolution.
RCxRules can capture patient historical HCC codes from a variety of sources. The majority of customers include the patient’s HCC history from their EMR and revenue cycle management systems. Additionally, many customers will supplement this HCC data with information from their population health management system, or from HCC information their payers can provide to them directly.
The RCxRules HCC coding solution is designed to fully complement your existing population health, EMR, and revenue cycle management systems. RCxRules has a variety of industry standard methods for achieving this integration and our focus is always on using the simplest approach required to meet your needs.
RCxRules has integrated with most major EMR and revenue cycle management systems. This list includes Epic, Cerner, Allscripts, GE, Athena, NextGen as well as many others. Contact us with specific integration questions.